AB0364 THE EFFECT OF BIOLOGIC AND TARGETED SYNTHETIC DISEASE MODIFYING ANTI-RHEUMATIC DRUGS ON WORK PARTICIPATION IN LONGSTANDING RHEUMATOID ARTHRITIS: RESULTS FROM A SYSTEMATIC LITERATURE REVIEW
Authors: A. Alunno, M. L. Marques, L. Falzon, S. Ramiro, A. Boonen
Journal: Annals of the Rheumatic Diseases (2022)

Background Work participation (WP) is a top priority for people with RA and a determinant of patients’ quality of life. Therefore, assessing the effect of interventions on WP outcomes is important. Objectives To review the effect of b/tsDMARDs on employment status (ES), sick leave (SL) and presenteeism in patients with longstanding RA. Methods A systematic literature review up to October 2021 was conducted using the PICOT framework (Figure 1). Two researchers independently screened abstracts, then full texts were reviewed to determine eligibility. Data from eligible articles were extracted. Heterogeneity and insufficient reporting of data precluded meta-analysis. Results We included 42 studies:16 randomized controlled trials (RCT) and 26 longitudinal observational studies (OBS). All studies were conducted with background therapy with csDMARDs; 33 (78%) in csDMARD-IR patients. RCTs provided short-term data only (≤24 weeks (w)) which have limited relevance for WP outcome domains such as ES 1 . OBS reported long-term data (≤ 5 years), albeit imposing challenges due to lack of random allocation to interventions and often lack of a comparator. Regarding ES, 6 RCTs and 4 OBS did not report significant differences in bDMARD-treated patients vs background csDMARDs. For SL (19 studies), 1 RCT showed that etanercept significantly reduced RA-related SL up to 12-16w; however, one OBS showed no such effect on the long-term. Conflicting results were obtained by 2 RCTs on baricitinib. Most compounds assessed in the 12 OBS without comparator reported improvement in SL up to 104w. For presenteeism (11 studies; Table 1), 4 RCTs showed that etanercept, golimumab, certolizumab pegol, baricitinib and peficitinib were superior to PBO+csDMARDs up to 12w. Two H2H studies assessing sarilumab and baricitinib vs adalimumab observed comparable presenteeism in all treatment arms at 12-16w. Table 1. Overview of presenteeism from RCTs and OBS with a comparator in csDMARD-IR patients AuthorYear InstrumentRecall period Intervention (I)¶Comparator (C)¶ N employed/N total Effect size From the article Computed SMD (95% CI) Bae2013 WPAI-GH7 d I: ETNC: csDMARD NR/197NR/103 % improvement49.623.6 -0.24 (-0.5; -0) Bingham2014 Self-composed single item4 w I: GOLC: PBO NR/395NR/197 Mean Δ (SD)–2.4 (2.8)–0.7 (4.5) - Emery2017 WPAI-RA7 d I: BARI 2mgI: BARI 4mgC: PBO 88/22976/22790/228 LSM Δ from BL (95% CI)−14 (−20 to −8)−16 (−22 to −11)−8 (−13 to −2) - Keystone 2017 WPAI-RA7 d I: BARIC: PBO 199/487206/488 LSM Δ from BL (95% CI)-18 (-22, -15)-10 (-13, -6) - Kavanaugh 2009 WPS-RA1 m I: CZP 200 mgI: CZP 400 mgC: PBO 132/393139/39069/199 NR -0.09 (-0.3; 0.1)-0.17 (-0.3; -0) Kavanaugh 2009 WPS-RA1 m I: CZP 200 mgI: CZP 400 mgC: PBO 101/24695/24649/127 NR -0.11 (-0.3; 0.1)-0.11 (-0.3; 0.1) Strand2018 WPS-RA1 m I: SARIC: ADA 78/184185 LSM Δ from BL (SE)-3.74 (0.5)-3.50 (0.5) - Kaeley2018 WPAI-RA7 d I: ADA + MTX 7.5mgC: ADA + MTX 20mg NR/154NR/155 NR 0.20 (-0.03-0.4) Tanaka2021 † WPAI7 d I: PEF100mg ± csDMARDsI: PEF150mg ± csDMARDsC: PBO 60/10453/10250/102 Mean Δ−12.2−18.73.6 - Tanaka2021 WPAI7 d I: PEF100mg ± MTXI. PEF150mg ± MTXC: PBO ± MTX 83/174101/17499/170 Mean Δ−11.6−16.9−2.7 - Tanaka2018 &amp; 2020* WPAI 7 days I: TCZC: csDMARDs 167/377160/347 Mean Δ-17.7-17.2 - *OBS WPAI, work productivity and activity index; WPS, work productivity survey; GH, global health; NR, not reported; LSM, least mean square; BL, baseline; CI, confidence interval; SE, standard error; SMD, standardized mean difference; d , days; w , weeks; m, month. ¶Added to background therapy with csDMARDs unless otherwise stated. Conclusion Short-term data from RCTs with background therapy with csDMARDs showed adding b/tsDMARDs was more effective than PBO in improving presenteeism. However, data on SL are conflicting and the positive results come from OBS without comparator. Future studies should consider existing guidance on the assessment of WP outcome domains to allow pooling and meta-analysis 1 . References [1]Boonen A, et al. Ann Rheum Dis. 2021;80:1116-23. Disclosure of Interests Alessia Alunno: None declared, Mary Lucy Marques: None declared, Louise Falzon: None declared, Sofia Ramiro: None declared, Annelies Boonen Speakers bureau: Abbvie, Galapagos, Consultant of: Galapagos, Grant/research support from: Abbvie